MARK A ELLISON Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****00

License Status

NOT RENEWED

Business

First Name

MARK A

Last Name

ELLISON

Business Name

MARK A ELLISON

Original Issue Date

05/07/1996

Effective Date

01/18/2006

Expiration Date

03/31/2008

City

STAUNTON

State

Zip

62088

County

MACOUPIN

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/02/2008